Chronic insomnia is more than a few bad nights of sleep. It can become a persistent, disabling disorder that affects how people think, feel, function and experience everyday life.
For people who have lived with insomnia for months—or even decades—the impact can be profound.
As Dr. Diane McIntosh explores in the PSYCHED UP podcast episode, This is Insomnia, one awful night of sleep can be difficult enough. But when one sleepless night becomes two, then three, then a pattern that repeats night after night, the effects can begin to take over a person’s life.
In the episode, Dr. McIntosh speaks with Allison, a 52-year-old woman who lived with insomnia for much of her adult life. Allison describes waking up exhausted, avoiding social activities because she was so tired and feeling as though there was “nothing good” about not sleeping.
Her experience illustrates why recognizing insomnia—and finding appropriate insomnia treatment—matters.
Listen to “This is Insomnia” on PSYCHED UP – or, go straight to Podbean.
What is chronic insomnia?
Insomnia isn’t simply choosing to stay up too late or occasionally having trouble sleeping.
Insomnia involves difficulty falling asleep, staying asleep, waking earlier than desired, or experiencing poor-quality sleep despite having adequate opportunity and circumstances for sleep. Importantly, it also causes daytime impairment.
Chronic insomnia disorder is generally characterized by these sleep difficulties occurring at least three times a week for at least three months, along with daytime symptoms such as fatigue, difficulty concentrating, irritability, low motivation or changes in mood.
Population estimates suggest that approximately 10–15% of adults experience persistent, troublesome insomnia.
That means insomnia is common—but that doesn’t make its impact any less serious.
What does insomnia feel like?
For someone experiencing chronic insomnia, the problem doesn’t necessarily end when they finally get out of bed.
After repeated nights of poor sleep, people may experience:
- Persistent daytime fatigue
- Difficulty concentrating or thinking clearly
- Irritability and reduced emotional resilience
- Low motivation and energy
- Anxiety about sleep itself
- Reduced enjoyment of social activities
- Difficulty functioning at work or home
- Increasing worry about what will happen when bedtime arrives
For Allison, the exhaustion became part of everyday life.
She describes waking up feeling as though she had “baseballs for eyes” and avoiding socializing because she simply didn’t have the energy.
Over time, insomnia can create a frustrating cycle: poor sleep can worsen daytime functioning and emotional well-being, while anxiety and worry about sleep can make it even harder to sleep.
Why can insomnia be difficult to recognize and treat?
Insomnia can be overlooked because difficulty sleeping is often treated as a symptom rather than a condition that deserves its own assessment.
A patient may present with fatigue, anxiety, low mood, poor concentration or difficulty functioning. Sleep may be discussed, but the underlying insomnia may not receive the attention it deserves.
There can also be a tendency to reach for a quick solution—particularly medication—without fully exploring the factors maintaining chronic insomnia.
That is one reason a structured assessment is important.
Insomnia can occur alongside other mental health conditions and medical problems, and clinicians need to consider the broader clinical picture when determining an appropriate treatment approach.
What is the most effective insomnia treatment?
For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) is a key evidence-based treatment and is recommended as first-line treatment in current clinical guidelines.
CBT-I is different from general sleep advice.
It is a structured treatment that addresses the thoughts and behaviours that can perpetuate insomnia. Depending on the program, it can include:
Stimulus control
This approach helps strengthen the association between the bed and sleep rather than wakefulness, frustration or worrying.
Sleep restriction therapy
Despite its name, sleep restriction therapy is not about simply depriving someone of sleep. It carefully adjusts time spent in bed to consolidate sleep, with the sleep window gradually adjusted as sleep efficiency improves.
Cognitive therapy
People with chronic insomnia can develop strong—and understandable—beliefs and fears about sleep: What if I don’t sleep tonight? How will I function tomorrow?
CBT-I addresses these thoughts and the anxiety that can develop around sleep.
Relaxation and counter-arousal strategies
These techniques can help reduce the mental and physical arousal that keeps someone awake.
Sleep education
Understanding how sleep works and establishing healthy sleep behaviours can be useful components of treatment.
Importantly, sleep hygiene alone is not considered an adequate stand-alone treatment for chronic insomnia. Current guidelines specifically recommend against relying on sleep hygiene education by itself.
What about medication for insomnia?
Medication can have a role in insomnia treatment, but it is not necessarily the best place to start for chronic insomnia.
Current guidance recommends CBT-I as first-line treatment, with medication considered in certain circumstances—for example, when someone cannot participate in CBT-I, continues to have significant symptoms despite treatment, or when medication is used as an adjunct in selected situations.
This is important because people struggling with sleep may be tempted to self-medicate with prescription medications, over-the-counter sleep aids, alcohol or supplements.
The risks and benefits can vary considerably depending on the medication, the individual’s health, other medications and the underlying cause of the sleep problem.
As Dr. McIntosh discusses in the podcast, treating insomnia isn’t simply about finding something that makes a person sleepy. The goal is to address the disorder and develop a sustainable treatment strategy.
Newer medications may offer additional options
The treatment landscape for insomnia continues to evolve.
In the podcast, Dr. McIntosh and psychologist Dr. Randy Mackoff discuss both behavioural treatment and newer medication options, providing a broader perspective on how clinicians can approach chronic insomnia.
For clinicians, staying current with the evidence matters. Medication selection involves considering factors such as the type of insomnia, expected benefits, tolerability, interactions, comorbid conditions and the patient’s individual circumstances.
Clinical decision support can help bring that information together at the point of care.
Treating insomnia means looking beyond sleep
One of the most important messages from Allison’s experience is that chronic insomnia can affect much more than bedtime.
When someone is exhausted every day, they may stop exercising, withdraw socially, struggle at work, become more irritable or lose interest in activities they once enjoyed.
And because insomnia and mental health can influence one another, clinicians may need to consider both sleep and psychiatric symptoms rather than treating either in isolation.
That makes accurate assessment especially important.
How Rapids Health supports insomnia treatment
For primary care clinicians, finding the time and resources to assess and treat complex mental health presentations can be challenging.
Soli by Rapids Health provides personalized diagnostic and treatment guidance for patients with insomnia and other psychiatric conditions. Soli automates the collection of clinical scales and patient information and provides a detailed report with evidence-based, personalized diagnostic and treatment guidance.
Ori by Rapids Health provides clinicians with immediate, evidence-based and expert-informed answers to questions about psychiatric treatment and medication management, including insomnia. Its guidance covers treatment approaches, medication information, dosing and management, tolerability and clinical considerations.
Together, these tools are designed to help bring psychiatric knowledge and evidence-informed treatment guidance closer to the point of care.
Chronic insomnia is treatable
Living with insomnia for years can make it feel as though sleeplessness is simply part of life.
It doesn’t have to be.
Effective insomnia treatment starts with recognizing chronic insomnia as a real clinical disorder and assessing the factors contributing to it. For many people, CBT-I provides an important foundation for treatment, while medication and other approaches may have a role depending on the individual clinical situation.
The conversation with Allison is a powerful reminder of what is at stake: treating insomnia isn’t simply about helping someone get a better night’s sleep.
It’s about helping them get their life back.
Listen to This is Insomnia
Hear Allison describe what it is really like to live with chronic insomnia, and listen to Dr. Diane McIntosh and Dr. Randy Mackoff discuss evidence-based treatment approaches.
Listen to “This is Insomnia” on PSYCHED UP – or, go straight to Podbean.
For Clinicians
Rapids Health provides evidence-based clinical decision support for insomnia, depression, anxiety, ADHD and bipolar disorder.
Learn about Soli by Rapids Health
This article is for educational purposes and does not replace individualized medical assessment or clinical judgment.